Approach to Diagnosis and Treatment of Hypercalcemia in a Patient With Malignancy

• Published in: American journal of kidney diseases Vol. 63; no. 1; pp. 141 - 147
• Main Authors: Reagan, Patrick, MD, Pani, Antonello, MD, Rosner, Mitchell H., MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-01-2014; Elsevier
• Subjects: Aged; Antineoplastic Agents - administration & dosage; Biological and medical sciences; bisphosphonate; Bone and Bones - metabolism; Bone Density Conservation Agents - administration & dosage; cancer; Carcinoma, Squamous Cell - complications; Carcinoma, Squamous Cell - pathology; Carcinoma, Squamous Cell - surgery; Diphosphonates - administration & dosage; Humans; Hypercalcemia; Hypercalcemia - blood; Hypercalcemia - diagnosis; Hypercalcemia - drug therapy; Hypercalcemia - etiology; Hypercalcemia - physiopathology; Kidney - metabolism; Male; Medical sciences; Mouth Mucosa - pathology; Mouth Neoplasms - complications; Mouth Neoplasms - pathology; Mouth Neoplasms - surgery; Multiple tumors. Solid tumors. Tumors in childhood (general aspects); Neoplasm Recurrence, Local; Nephrology; Nephrology. Urinary tract diseases; Parathyroid Hormone-Related Protein - blood; parathyroid hormone–related protein; Rehydration Solutions - administration & dosage; Sodium Chloride - administration & dosage; Treatment Outcome; Tumors; Hypercalcemia; bisphosphonate; cancer; parathyroid hormone–related protein; Human; Hydroelectrolytic balance disorder; Nephrology; Antiosteoporotic; Calcium; parathyroid hormone-related protein; Malignancy; Malignant tumor; Bisphosphonates; Inorganic element; Urology; Metabolic disorder; Treatment; Antiosteoclastic agent; Parathyroid hormone related peptide; Diagnosis; Cancer
• ISSN: 0272-6386; 1523-6838
• DOI: 10.1053/j.ajkd.2013.06.025

Hypercalcemia is a common complication of malignancy and portends a worse prognosis. It causes a variety of symptoms in patients, which can range from confusion and polyuria to coma and death. There are 4 broad mechanistic categories to classify hypercalcemia of malignancy: local osteolysis secondary to metastatic cancer or multiple myeloma, excess parathyroid-related hormone, excess 1,25-dihydroxyvitamin D production, and ectopic parathyroid hormone production. Volume expansion with normal saline solution and treatment with intravenous bisphosphonates to decrease osteoclast-mediated bone destruction are effective initial therapies. Calcitonin, gallium nitrate, and corticosteroids can serve as adjunctive therapies. Denosumab is an attractive therapeutic option for refractory cases of hypercalcemia, although more data are required before this therapy can be recommended.